长型股骨近端髓内钉治疗同侧股骨近端和股骨干骨折
Long proximal femoral nail in ipsilateral fractures proximal femur and shaft of femur.
作者信息
Gadegone Wm, Lokhande Vijayanand, Salphale Yogesh, Ramteke Alankar
机构信息
Consultant Orthopaedic Surgeon, Chandrapur Multispeciality Hospital, Vivek- nagar Chandrapur, India.
出版信息
Indian J Orthop. 2013 May;47(3):272-7. doi: 10.4103/0019-5413.109441.
BACKGROUND
Ipsilateral fractures of the proximal femur and femoral shaft are extremely uncommon injuries which occur in young adults who sustain a high energy trauma. A variety of management modalities have been tried to treat this complex fracture pattern ranging from conservative approach to recently introduced reconstruction nails. All these approaches have their own difficulties. We studied the outcome of long proximal femoral nail (LPFN) in the management of concomitant ipsilateral fracture of the proximal femur and femoral shaft.
MATERIALS AND METHODS
We analysed the prospective data of 36 consecutive patients who had sustained a high energy trauma (30 closed fractures and 6 open shaft fractures) who had concomitant ipsilateral fractures of the femoral shaft associated with proximal femur fractures treated with LPFN between December 2005 and December 2011. The mean age was 39 years (range 28-64 years). Twenty nine males and seven females were enrolled for this study.
RESULTS
The patients were followed up at three, six, twelve, and eighteen months. The mean healing time for the neck fractures was 4.8 months and for the shaft fractures was 6.2 months. The greater trochanter was splintered and widened in two cases which eventually consolidated. Two patients had superficial infection, two patients had lateral migration of the screws with coxa vara which was due to severe osteoporosis detected during the followup. We had two cases of nonunion of shaft fracture and one case of nonunion of neck fracture. Two cases of avascular necrosis of femoral head were detected after 2 years of followup. No cases of implant failure were noted. Limb shortening of less than 2 cms was noted in four of our patients. The functional assessment system of Friedman and Wyman was used for evaluating the results. In our series 59.9% (n = 23) were rated as good, 30.6% (n = 11) as fair, and 5.5% (n = 2) as poor.
CONCLUSION
Long PFN is a reliable option for concomitant ipsilateral diaphyseal and proximal femur fractures.
背景
同侧股骨近端和股骨干骨折是极为罕见的损伤，多见于遭受高能量创伤的年轻成年人。从保守治疗方法到最近引入的重建钉，人们尝试了多种治疗方式来处理这种复杂的骨折类型。所有这些方法都有各自的困难。我们研究了长型股骨近端钉（LPFN）治疗同侧股骨近端和股骨干骨折的疗效。
材料与方法
我们分析了2005年12月至2011年12月期间36例因高能量创伤导致同侧股骨干骨折合并股骨近端骨折（30例闭合性骨折和6例开放性股骨干骨折）且接受LPFN治疗的连续患者的前瞻性数据。平均年龄为39岁（范围28 - 64岁）。本研究纳入29例男性和7例女性。
结果
对患者进行了3个月、6个月、12个月和18个月的随访。股骨颈骨折的平均愈合时间为4.8个月，股骨干骨折的平均愈合时间为6.2个月。2例大转子出现粉碎和增宽，最终愈合。2例患者发生浅表感染，2例患者因随访期间发现严重骨质疏松导致螺钉向外侧移位并出现髋内翻。我们有2例股骨干骨折不愈合和1例股骨颈骨折不愈合。随访2年后发现2例股骨头缺血性坏死。未观察到植入物失败的病例。4例患者肢体短缩小于2厘米。采用Friedman和Wyman功能评估系统评估结果。在我们的系列研究中，59.9%（n = 23）被评为良好，30.6%（n = 11）为中等，5.5%（n = 2）为差。
结论
长型PFN是治疗同侧股骨干和股骨近端骨折的可靠选择。
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